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Does CBD help
with arthritis
pain?
April 10, 2020
By Robert H. Shmerling, MD, Senior Faculty
Editor, Harvard Health Publishing
If you have chronic arthritis pain, you may
be wondering about cannabidiol (CBD) as a
treatment. CBD, along with delta-9tetrahydrocannabinol (THC) and other
chemicals, is found in marijuana. But
unlike THC, CBD is not “psychoactive” —
that is, it does not cause the intoxication or
high associated with marijuana use.
There’s a good chance you’ve tried it
already: according to a Gallup poll in
August of 2019, about 14% of Americans
report using CBD products, and the number
one reason is pain. The Arthritis
Foundation conducted its own poll and
found that 29% reported current use of CBD
(mostly in liquid or topical form), and
nearly 80% of respondents were either
using it, had used it in the past, or were
considering it. Of those using it, most
reported improvement in physical
function, sleep, and well-being; of note, a
minority reported improvement in pain or
stiffness.
Perhaps you’ve been tempted to try it. After
all, most types of arthritis are not cured by
other treatments, and CBD is considered a
less addictive option than opiates. Or
maybe it’s the marketing that recommends
CBD products for everything from arthritis
to anxiety to seizures. The ads are pretty
hard to miss. (Now here’s a coincidence: as
I was writing this, my email preview pane
displayed a message that seemed to jump
off the screen: CBD Has Helped Millions!!
Try It Free Today!)
What’s the evidence it works? And what do
experts recommend? Until recently, there’s
been little research and even less guidance
for people (or their doctors) interested in
CBD products that are now increasingly
legal and widely promoted.
But now, there is.
A word about arthritis
pain
It’s worth emphasizing that there are more
than 100 types of arthritis, and while pain
is a cardinal feature of all of them, these
conditions do not all act alike. And what
works for one may not work for another.
Treatment is aimed at reducing pain and
stiffness and maintaining function for all
types of arthritis. But for certain
conditions, such as rheumatoid arthritis,
conventional prescription medications are
highly recommended, because these drugs
help prevent permanent joint damage and
worsening disability.
In addition, individuals experience pain
and respond to treatment in different
ways. As a result, it’s highly unlikely that
there is a single CBD-containing product
that works for all people with all types of
arthritis.
What’s the evidence that
CBD is effective for
chronic arthritis pain?
While there are laboratory studies
suggesting CBD might be a promising
approach, and animal studies showing
anti-inflammatory and pain-relieving
effects, well-designed studies
demonstrating compelling evidence that
CBD is safe and effective for chronic
arthritis pain in humans do not exist. A
randomized trial of topical CBD for
osteoarthritis of the knee has been
published, but in abstract form only
(meaning it’s a preliminary report that
summarizes the trial and has not been
thoroughly vetted yet); the trial lasted only
12 weeks, and results were mixed at best.
One of the largest reviews examined the
health effects of cannabis and CBD, and
concluded that there is “substantial
evidence that cannabis is an effective
treatment for chronic pain in adults.” But
there was no specific conclusion regarding
CBD, presumably because definitive studies
were not available.
Of course, there is anecdotal evidence and
testimonials galore, including reports of
dramatic improvement by people who tried
CBD in its various forms (including
capsule, liquid, topical, and spray) for their
pain. But we are still waiting for welldesigned, scientifically valid, and rigorous
clinical trials (such as this one in progress)
that are so badly needed to answer the
question of just how helpful CBD may be to
people with chronic arthritis pain.
Are there downsides to
CBD treatment?
As with any treatment, there can be
downsides. CBD is generally considered
safe; however, it can still cause
lightheadedness, sleepiness, dry mouth,
and rarely, liver problems. There may be
uncertainty about the potency or purity of
CBD products (since they are not regulated
as prescription medications are), and CBD
can interact with other medications. For
pregnant women, concern has been raised
about a possible link between inhaled
cannabis and lower-birthweight babies; it’s
not clear if this applies to CBD. Some pain
specialists have concerns that CBD may
upset the body’s natural system of pain
regulation, leading to tolerance (so that
higher doses are needed for the same
effect), though the potential for addiction is
generally considered to be low.
There is one definite downside: cost. Prices
range widely but CBD products aren’t
inexpensive, and depending on dose,
frequency, and formulation, the cost can be
considerable — I found one brand that was
$120/month, and health insurance does not
usually cover it.
Are there guidelines
about the use of CBD for
chronic arthritis pain?
Until recently, little guidance has been
available for people with arthritis pain who
were interested in CBD treatment.
Depending on availability and interest,
patients and their doctors had to decide on
their own whether CBD was a reasonable
option in each specific case. To a large
degree that’s still true, but some guidelines
have been published. Here’s one set of
guidelines for people pursuing treatment
with CBD that I find quite reasonable
(based on recommendations from the
Arthritis Foundation and a recent
commentary published in the medical
journal Arthritis Care & Research):
Dos:
If considering a CBD product, choose
one that has been independently tested
for purity, potency, and safety — for
example, look for one that has received
a “Good Manufacturing Practices”
(GMP) certification.
CBD should be one part of an overall
pain management plan that includes
nonmedication options (such as
exercise) and psychological support.
Choose an oral treatment (rather than
inhaled products) and start with a low
dose taken in the evening.
Establish initial goals of treatment
within a realistic period of time — for
example, a reduction in knee pain that
allows you to walk around the block
within two weeks of starting
treatment; later, if improved, the goals
can be adjusted.
Tell your doctor(s) about your planned
and current CBD treatment; monitor
your pain and adjust medications with
your medical providers, rather than
with nonmedical practitioners (such as
those selling CBD products).
Don’ts:
Don’t make CBD your first choice for
pain relief; it is more appropriate to
consider it if other treatments have not
been effective enough.
Don’t have nonmedical practitioners
(such as those selling CBD products)
managing your chronic pain; pain
management should be between you
and your healthcare team, even if it
includes CBD.
For people with rheumatoid arthritis or
related conditions, do not stop
prescribed medications that may be
protecting your joints from future
damage; discuss any changes to your
medication regimen with your doctor.
The bottom line
If you’re interested in CBD treatment for
chronic arthritis pain or if you’re already
taking it, review the pros, cons, and latest
news with your healthcare providers, and
together you can decide on a reasonable
treatment plan. Depending on the type of
arthritis you have, it may be quite
important to continue your conventional,
prescribed medications even if you pursue
additional relief with CBD products.
We may not have all the evidence we’d
like, but if CBD can safely improve your
symptoms, it may be worth considering.
Follow me on Twitter @RobShmerling
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R EAD MO RE
DISEASES & CONDITIONS
Casing the joints
PAIN
Take on chronic pain
where it lives
PAIN
Chronic inPammation
and your joints
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